You are middle-aged and have new symptoms after your COVID infection: fatigue, brain fog, joint pain. Is it long COVID? Or are you just getting old?
If you’ve wondered, you’re not alone.
“It’s a trick,” says Dr. Alba Miranda Azola, co-director of the long-running COVID clinic at Johns Hopkins University School of Medicine, said Fortune.
Given that the world has seen just under 650 million officially registered COVID cases-and that about 10% of the world’s population is 65 or older – aging and long COVID are linked in a big way. This is especially true given that the aging process, for many, becomes noticeable from early middle age.
As patients get older, “I think it gets a little muddy,” Azola said.
Currently, there are no official diagnostic criteria for long COVID. Even the definition of the condition varies depending on who you talk to, though it’s generally considered new symptoms that start during a COVID infection or appear after an infection, and persist for weeks or months.
Complications, symptoms, and timing of aging can vary widely due to genetic and environmental factors. So it’s not possible to tell for sure whether your new symptoms are due to aging or long COVID, both or neither, say Azola and other experts.
“Could this be long COVID? The short answer is yes,” she said. “But it’s hard to determine if this is a long COVID or if other things are contributing to it.”
A ‘chicken or the egg?’ dilemma
With Over 200 symptoms identified– from persistent coughing and fatigue to numbness in the ears and a “brain on fire” feeling – long COVID is undoubtedly not one but several conditions, experts say.
True long COVID, according to many people, is best defined as a chronic fatigue syndrome-like condition that develops after COVID infection, similar to other postviral syndromes that can occur after infection with herpes, Lyme disease and Ebola, among others.
Other post-COVID complications like organ damage should not be defined as long COVIDs and better fit into the broader PASC category, experts say. Also known as post-acute sequelae of COVID-19the term is used to encompass a wide variety of consequences of COVID, from chronic fatigue-like symptoms to later symptoms heart disease long-lasting lung damage strange new symptoms like urinary incontinence, itching and skin irritation.
Signs of aging can overlap with long COVID, or at least look like they do. They often include back and neck pain, osteoarthritis, chronic obstructive pulmonary disease, and dementia, among others. according to the World Health Organizationin addition to fatigue.
Officially diagnosed or not, it is estimated that almost 60% of the world’s population has been infected with COVID, according to the Institute of Health Metrics and Evaluation at the University of Washington. Now that the majority of the world’s citizens have been infected with the virus, it is difficult to determine what new symptoms and conditions the virus caused or contributed to, said Dr. Nir Goldstein, a pulmonologist at National Jewish Health in Denver who runs the hospital’s long-running COVID clinic.
“It becomes clinically difficult to temporally define causality,” he said. Fortune.
The timing as such
Symptoms of aging tend to come on gradually, says Dr. Panagis Galiatsatos, an assistant professor in the Johns Hopkins Division of Pulmonary and Critical Care Medicine who sees long COVID patients, said Fortune. This is not the case with the long COVID.
“There really is a stark difference between ‘Before I felt like this’ and ‘After I felt like this,'” he said of the long COVID symptoms after a COVID infection. “I don’t see too many people confusing their symptoms with aging.”
“A lot of patients will tell you that they feel like they’ve aged after COVID,” he added.
Azola has many elderly patients who have been less active over the past two years due to pandemic restrictions and are now complaining that exercise is wearing them out. Decreased activity during the pandemic — not the virus — might be to blame, at least for some of their symptoms, she said.
“The older population experiences a mixture of decreased activity during the years of isolation and then deconditioning,” she said.
“Most respond well to more physical approaches to activity progression” or physical therapy, she said.
For now, it doesn’t matter what’s causing your symptoms, experts say, because no treatments specifically for long COVID have been approved. Doctors treat the symptoms, whatever the cause.
Eventually, the cause of the symptoms could matter if the exact mechanisms behind long COVID are determined and treatments are developed, Goldstein said.
“But at this point, practically, it’s not,” he said.
This story was originally featured on Fortune.com
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